| NPI | 1184851545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA 14057) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 487853) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2024-05-02 |