| NPI | 1730157868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA58267) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 5972709-1206) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2026-03-10 |