| NPI | 1477074094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA pa54581) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA PA54581) |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2024-10-21 |