NPI | 1669503785 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA10944) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 220972) |
Enumeration Date | 2007-03-08 |
Last Update Date | 2013-07-19 |