| NPI | 1871522110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA10123) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA PA10123) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2020-11-07 |