| NPI | 1740067396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA66132) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 66132) |
| 363A00000X Physician Assistant (Licence: CA PA66132) | |
| Enumeration Date | 2023-09-08 |
| Last Update Date | 2026-03-03 |