| NPI | 1336182864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA17357) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 45117) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2026-03-12 |