| NPI | 1710186721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA ML5329) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9103047) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2020-08-31 |