| NPI | 1194426452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA65689) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 1206358) |
| 363A00000X Physician Assistant (Licence: NV 1206358) | |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2025-08-06 |