| NPI | 1487604948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 19182) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10000768A) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2021-11-29 |