| NPI | 1588203756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA61965) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 024858) |
| 363A00000X Physician Assistant (Licence: CA 61965) | |
| Enumeration Date | 2020-01-05 |
| Last Update Date | 2023-03-20 |