NPI | 1124020706 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 17096) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 14495) |
Enumeration Date | 2005-08-12 |
Last Update Date | 2015-05-19 |