| NPI | 1659542389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA19685) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: WA PA60506942) | |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2019-09-17 |