| NPI | 1740530518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA22357) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015836) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2015-04-28 |