| NPI | 1639729833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA57205) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 12288) |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2024-05-04 |