| NPI | 1942219233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-1099) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA PA11201) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2014-07-08 |