| NPI | 1871841015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 7989) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA22467) |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2024-02-01 |