| NPI | 1457617383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA52451) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 1039) |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2023-11-03 |