| NPI | 1477923019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA53516) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 019116) |
| Enumeration Date | 2015-09-25 |
| Last Update Date | 2016-10-06 |