| NPI | 1982752440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA21817) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011652) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2022-07-21 |