| NPI | 1245616473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 64884) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 8772) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2025-10-27 |