| NPI | 1568218824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA65604) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2024-04-27 |
| Last Update Date | 2025-03-12 |