| NPI | 1093423311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA61826) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 61826) |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2026-01-07 |