NPI | 1790080182 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA20054) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 20641) |
Enumeration Date | 2011-01-17 |
Last Update Date | 2015-11-19 |