| NPI | 1689924581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA16694) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA156961) |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2020-09-16 |