NPI | 1073229746 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA64181) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2023-01-26 |
Last Update Date | 2024-08-20 |