| NPI | 1184449365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA65884) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2024-11-21 |
| Last Update Date | 2025-06-16 |