NPI | 1053942888 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA58445) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2020-01-30 |
Last Update Date | 2021-07-26 |