| NPI | 1871771873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA19568) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA PA19568) |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2018-10-17 |