| NPI | 1447039458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 68301) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: CA 68301) | |
| Enumeration Date | 2023-09-28 |
| Last Update Date | 2026-08-31 |