| NPI | 1558316786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA15710) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP13052) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2022-01-03 |