| NPI | 1639299647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA15565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA PA15565) |
| 207V00000X Obstetrics & Gynecology (Licence: CA PA15565) | |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2023-01-09 |