| NPI | 1669139879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA60602) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA2557) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2021-11-22 |
| Last Update Date | 2025-11-06 |