| NPI | 1699867085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA20723) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 004487) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2015-09-25 |