| NPI | 1467430942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA002013L) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 52766) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2020-08-30 |