NPI | 1194000653 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA65244) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
Enumeration Date | 2011-10-17 |
Last Update Date | 2025-04-28 |