| NPI | 1568715407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 52460) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 002335) |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2022-11-02 |