| NPI | 1720382393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA21345) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 21345) |
| Enumeration Date | 2010-12-22 |
| Last Update Date | 2014-11-13 |