| NPI | 1669421749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA15619) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA Q61461) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2022-02-23 |