| NPI | 1780889477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 19181) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA19181) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2023-10-17 |