| NPI | 1255896551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA PA61427) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0009123) |
| 363A00000X Physician Assistant (Licence: NV PA2087) | |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2026-05-27 |