| NPI | 1598172272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 56369) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110004601) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2020-07-29 |