| NPI | 1700119567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA20295) |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2023-11-27 |