| NPI | 1265175574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 60940) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 1176665) |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2024-01-18 |