| NPI | 1457727885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 363A00000X Physician Assistant (Licence: CA 59729) | |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2022-12-15 |