| NPI | 1356667539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA PA20823) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA20823) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2011-02-11 |