| NPI | 1700428711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA57291) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 57291) |
| Enumeration Date | 2019-10-10 |
| Last Update Date | 2024-09-25 |