| NPI | 1417074907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP 16596) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA 19007) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2022-03-15 |