| NPI | 1477867893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA13145) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 467220) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2010-07-27 |