NPI | 1063870616 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55400) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 55400) |
207R00000X Internal Medicine (Licence: CA 55400) | |
363AM0700X Physician Assistant, Medical (Licence: CA 55400) | |
Enumeration Date | 2016-02-10 |
Last Update Date | 2024-06-06 |