| NPI | 1992761449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA15354) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA 15354) |
| 363A00000X Physician Assistant (Licence: CA PA 15354) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2024-01-30 |