| NPI | 1841715232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-1119) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 54903) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2022-02-17 |