| NPI | 1629304332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5421) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA20580) |
| Enumeration Date | 2009-10-30 |
| Last Update Date | 2020-10-15 |