| NPI | 1730348087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA56031) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2021-01-19 |