| NPI | 1598927501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA PA19682) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: CA PA19682) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2010-09-08 |