| NPI | 1851877930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 57284) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 8350108-1206) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2023-04-20 |