| NPI | 1457021149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA60239) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2024-03-13 |