Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Individual
THUC N LY
Active
Individual
THUC N LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA16370
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
952662606
GRP TAX ID #
CA
Enumeration date
08/31/2006
Last updated
05/27/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up