| 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 |