| NPI | 1245963545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 65083) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9119376) |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2025-09-25 |