| NPI | 1487077426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 52396) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 2431) |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2022-10-27 |