| NPI | 1548314735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA 16872) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA FNP 13919) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2021-03-30 |