| NPI | 1447624911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 53309) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 7659) |
| Enumeration Date | 2015-11-21 |
| Last Update Date | 2024-02-15 |