| NPI | 1992133573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 55460) |
| Additional Taxonomies | 171100000X Acupuncturist |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2013-10-17 |
| Last Update Date | 2023-10-03 |