NPI | 1073807897 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 23214) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA 23214) |
Enumeration Date | 2011-06-09 |
Last Update Date | 2023-04-05 |