| NPI | 1467563320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA13820) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2015032407) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-02-09 |