| NPI | 1144769332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 57620) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-07098) |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2023-12-12 |