| 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 |