| NPI | 1457307670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA58015) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10003701) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2024-06-07 |