| NPI | 1891929808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA22748) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 005540) |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2013-01-23 |