| NPI | 1861674673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA22214) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1570) |
| 363A00000X Physician Assistant (Licence: NC 001001863) | |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2024-01-08 |