| NPI | 1962997973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA55687) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 55687) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2019-01-07 |