| NPI | 1922276948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA19118) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA PA19118) |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2020-02-20 |