| NPI | 1801186937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 59474) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 014716) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2024-06-04 |