| NPI | 1235753856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA58372) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2025-03-27 |