| NPI | 1962482877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 17521) |
| Additional Taxonomies | 207RX0202X Internal Medicine, Medical Oncology (Licence: CA PA17521) |
| 364SE0003X Clinical Nurse Specialist, Emergency (Licence: CA PA17521) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2025-02-07 |