| NPI | 1801315262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 57607) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 6852) |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2024-08-14 |