| NPI | 1477675825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 58729) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 009879-1) |
| Enumeration Date | 2007-04-05 |
| Last Update Date | 2021-12-09 |