| NPI | 1477049781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 59785) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2023-01-31 |