| NPI | 1467995803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 54216) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9110133) |
| Enumeration Date | 2016-12-01 |
| Last Update Date | 2022-10-28 |