| NPI | 1073504403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA14504) |
| Additional Taxonomies | 364SE0003X Clinical Nurse Specialist, Emergency (Licence: CA PA14504) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2020-11-18 |