| NPI | 1083380885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA CA60335) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA CA60335) |
| Enumeration Date | 2021-08-20 |
| Last Update Date | 2025-01-08 |