| NPI | 1699855080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA NP 8934) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: FL PA9118623) |
| 363AM0700X Physician Assistant Medical (Licence: CA PA14013) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2025-02-11 |