| NPI | 1619529518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA61646) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-008017) |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2025-05-06 |