NPI | 1053563965 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 4601) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA20030) |
Enumeration Date | 2008-10-22 |
Last Update Date | 2020-09-15 |