| NPI | 1316648181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA67168) |
| Enumeration Date | 2023-03-16 |
| Last Update Date | 2026-02-23 |