| NPI | 1477883908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA pa62380) |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2024-05-12 |