| NPI | 1134887029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 60927) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2022-06-03 |