| NPI | 1740301191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 13005) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA13005) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2024-07-29 |