| NPI | 1093327785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8241) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA66233) |
| Enumeration Date | 2020-08-23 |
| Last Update Date | 2025-10-10 |