| NPI | 1437748191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 62817) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA2442) |
| Enumeration Date | 2021-01-15 |
| Last Update Date | 2025-09-29 |