| NPI | 1083352397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA61179) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2022-06-10 |