| NPI | 1508820648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA13332) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA13332) |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA13332) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2024-02-02 |