| NPI | 1881763639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 12098) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CA PA12098) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2021-01-22 |