NPI | 1124074877 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA16598) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA16598) |
Enumeration Date | 2006-05-25 |
Last Update Date | 2019-03-19 |