| NPI | 1558556423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA 20208) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA AT 5950) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2022-01-03 |