| NPI | 1801825195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54524) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C02993) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2020-01-22 |