| NPI | 1871708859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 19169) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA 4374) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2018-03-23 |