| NPI | 1285017335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA52610) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 52610) |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA61335017) | |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2025-07-07 |