| NPI | 1538662937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA 55373) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: CA 55373) |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2018-03-17 |