| NPI | 1831132968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 51591) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 347) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2014-09-02 |