| NPI | 1225504301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA PA56123) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA56123) |
| Enumeration Date | 2018-10-16 |
| Last Update Date | 2024-08-15 |