| NPI | 1144523739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA65943) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA 9105630) |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2025-11-24 |