| NPI | 1780892869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 53033) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 11675) |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2018-09-26 |