| NPI | 1710799655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA65961) |
| Enumeration Date | 2025-01-27 |
| Last Update Date | 2026-09-24 |