| NPI | 1003480005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA61496) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2024-05-02 |