| NPI | 1285245894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA60166) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9115952) |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2025-02-06 |