| NPI | 1447865027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA58634) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2024-03-27 |