| NPI | 1851359327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA15328) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA15328) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2008-10-02 |