| NPI | 1689174146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55344) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 7083) |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2019-03-11 |