| NPI | 1932585361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 52488) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA52488) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2022-03-01 |