| NPI | 1487834644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA20137) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 67569041206) |
| 363A00000X Physician Assistant (Licence: ID PA-854) | |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2023-07-18 |