| NPI | 1467846147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA53605) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05629) |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2020-12-04 |