| NPI | 1093217895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 67476) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 49198) |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2025-12-22 |