| NPI | 1578658746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA21728) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: CT 000901) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2016-06-28 |