NPI | 1033614730 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55378) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0008047) |
Enumeration Date | 2018-03-26 |
Last Update Date | 2023-11-07 |