| NPI | 1457634008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA21862) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5892) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2022-09-22 |