| NPI | 1982808234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 51333) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA TMA051734) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2015-07-23 |