| NPI | 1245998004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA60553) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD-1490) |
| Enumeration Date | 2021-11-29 |
| Last Update Date | 2025-09-21 |