| NPI | 1467576421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA 12379) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA PA12379) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2016-01-12 |