| NPI | 1891424370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 63915) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-2300) |
| 363A00000X Physician Assistant (Licence: 1191213) | |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2024-05-02 |