| NPI | 1861477648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 005073) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA16336) |
| 367H00000X Anesthesiologist Assistant (Licence: GA 005073) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2011-02-28 |