| NPI | 1760497267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA16868) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA00945) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2022-01-03 |