| NPI | 1558557785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 20371) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 005159) |
| 363A00000X Physician Assistant (Licence: NC 0010-03251) | |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2015-02-23 |