| NPI | 1376568360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 13525) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CA 487125) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2009-11-09 |