| NPI | 1609541192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA60181) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2021-12-02 |