| NPI | 1932657194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA65422) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA13087) |
| Enumeration Date | 2016-09-16 |
| Last Update Date | 2026-05-04 |