| NPI | 1588121354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 58091) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SD 1269) |
| Enumeration Date | 2019-02-27 |
| Last Update Date | 2025-06-07 |