| NPI | 1619150752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA21631) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA723) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2023-04-26 |