| NPI | 1902036940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 51762) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 745959) |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2015-09-22 |