NPI | 1114128006 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55237) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP10568) |
Enumeration Date | 2007-05-30 |
Last Update Date | 2018-08-13 |