| NPI | 1992948764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 57555) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 1086068) |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2020-02-07 |