| NPI | 1891833786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 52160) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA AT 6459) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2021-12-27 |