| NPI | 1013645381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA61504) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-08-12 |
| Last Update Date | 2022-11-11 |