| NPI | 1619023769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA 18366) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT20351) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2007-11-17 |