| NPI | 1679971352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PSY58721) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA 60512154) |
| Enumeration Date | 2014-12-12 |
| Last Update Date | 2024-01-18 |