| NPI | 1629047931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA1623) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA16906) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2023-08-16 |