NPI | 1093209843 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55561) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA55561) |
Enumeration Date | 2018-06-15 |
Last Update Date | 2021-06-09 |