NPI | 1043641822 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-07561) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA51287) |
Enumeration Date | 2013-12-04 |
Last Update Date | 2020-03-24 |