| NPI | 1295130185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55023) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1992) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2024-03-30 |