| NPI | 1508038043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 17751) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA 17751) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2021-11-29 |