| NPI | 1386343259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 65609) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9117126) |
| Enumeration Date | 2023-02-28 |
| Last Update Date | 2026-01-22 |