| NPI | 1447538236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 21697) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA PA200691) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2020-10-20 |