NPI | 1033540554 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 21321) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 21321) |
Enumeration Date | 2013-12-09 |
Last Update Date | 2024-12-05 |