| NPI | 1205926052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA17553) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: CA PA17553) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2024-08-01 |