| NPI | 1952334914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3456) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA18305) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2007-10-24 |