| NPI | 1609990167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA16984) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 008000-1) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2007-07-08 |