| NPI | 1679927834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA59155) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD671) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2021-10-13 |