| NPI | 1831380161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4776) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA19278) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2025-11-20 |