| NPI | 1710174255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA19344) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 98456) |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2021-06-04 |