| NPI | 1407470438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 61688) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2023-02-01 |