| NPI | 1326529769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA58952) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA12126) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2021-10-06 |