| NPI | 1265823561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 65265) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61400999) |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2025-02-24 |