| NPI | 1760358162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 67345) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA70027024) |
| Enumeration Date | 2025-10-13 |
| Last Update Date | 2026-04-08 |