| NPI | 1679935589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 54536) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA058124) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2023-06-06 |