| NPI | 1710495023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA60933) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 021587) |
| Enumeration Date | 2018-01-21 |
| Last Update Date | 2024-07-19 |