NPI | 1083288914 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA61852) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2021-05-15 |
Last Update Date | 2023-12-20 |