| NPI | 1457503625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 53822) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 012837) |
| Enumeration Date | 2008-10-18 |
| Last Update Date | 2023-08-11 |