NPI | 1073520581 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA22496) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10003694) |
363AM0700X Physician Assistant, Medical (Licence: WA PA10003694) | |
363A00000X Physician Assistant (Licence: CA PA22496) | |
Enumeration Date | 2006-08-01 |
Last Update Date | 2014-07-01 |