| NPI | 1720032717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-551) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA 15723) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2021-06-29 |