| NPI | 1619345899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 63754) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9108951) |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2024-07-23 |