| NPI | 1932612306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55054) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 843383) |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2024-06-17 |