| NPI | 1659445971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 20090) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2023-08-08 |