NPI | 1497940407 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA16210) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 13918) |
Enumeration Date | 2007-09-12 |
Last Update Date | 2019-11-08 |