| NPI | 1992952170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 58763) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0000606) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2022-12-21 |