| NPI | 1730334152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54161) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 008826) |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2022-05-25 |