| NPI | 1740965383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA62912) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA PA62912) |
| 207W00000X Ophthalmology (Licence: CA PA62912) | |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2025-07-19 |