NPI | 1508901232 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA PA11430) |
Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA PA11430) |
Enumeration Date | 2007-02-20 |
Last Update Date | 2014-07-03 |