| NPI | 1881830644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 19050) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NP17079) |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2018-01-31 |