| NPI | 1497347975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 61933) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 3720) |
| Enumeration Date | 2021-02-06 |
| Last Update Date | 2023-02-27 |