| NPI | 1760133953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 60800) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0008256) |
| Enumeration Date | 2022-01-10 |
| Last Update Date | 2023-07-09 |