| NPI | 1568488195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA18311) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NP 16826) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2016-06-13 |