| NPI | 1518269067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 56828) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 014340-1) |
| Enumeration Date | 2010-12-03 |
| Last Update Date | 2024-05-17 |