| NPI | 1497834402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA16167) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 16167) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2023-03-07 |