| NPI | 1720726680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 61135) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 61135) |
| Enumeration Date | 2022-05-21 |
| Last Update Date | 2025-12-19 |