| NPI | 1790359081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 1790359081) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2025-02-13 |