| NPI | 1932294279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA16654) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA PA16654) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2019-09-07 |