| NPI | 1689100802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA65281) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA 9109507) |
| Enumeration Date | 2017-05-08 |
| Last Update Date | 2024-10-18 |