| NPI | 1700280443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA53195) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 001005307) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 001005307) | |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2018-10-08 |