| NPI | 1336280015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 19051) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 15217) |
| 163W00000X Registered Nurse (Licence: CA 527057) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2019-07-03 |