| NPI | 1235148289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA12560) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: CA PA12560) |
| 363AM0700X Physician Assistant, Medical (Licence: AZ 3589) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2016-11-21 |