| NPI | 1447325840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 18170) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 008211) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2018-12-24 |