| NPI | 1821181751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 4579) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 16716) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-08-05 |