| NPI | 1649240722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA18490) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA756) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2014-06-19 |