| NPI | 1851470868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 15359) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA15359) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2008-04-30 |