| NPI | 1700678364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA66572) |
| Enumeration Date | 2025-05-20 |
| Last Update Date | 2025-08-07 |