| NPI | 1063870616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 55400) |
| 207R00000X Internal Medicine (Licence: CA 55400) | |
| 363AM0700X Physician Assistant, Medical (Licence: CA 55400) | |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2024-06-06 |