| NPI | 1457808941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA57789) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA 1760) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2021-08-09 |