NPI | 1043545866 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 65506) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9105141) |
Enumeration Date | 2009-10-13 |
Last Update Date | 2024-12-04 |