| NPI | 1609039965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 59887) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 5350) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2024-09-11 |