| NPI | 1225674666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA57903) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD-1281) |
| Enumeration Date | 2019-11-20 |
| Last Update Date | 2024-11-21 |