| NPI | 1437745734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 64563) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9113716) |
| Enumeration Date | 2020-12-21 |
| Last Update Date | 2025-01-14 |