| NPI | 1639289614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA17266) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA17266) |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA17266) | |
| 207RR0500X Internal Medicine, Rheumatology (Licence: CA PA17266) | |
| 207X00000X Orthopaedic Surgery (Licence: CA PA17266) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-03-07 |