| NPI | 1740629047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 22983) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 1106732) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2018-09-25 |