| NPI | 1932594140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 52383) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003526) |
| 171100000X Acupuncturist (Licence: PA KO000629) | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2017-11-01 |