NPI | 1124270277 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA19914) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA151001) |
Enumeration Date | 2008-10-21 |
Last Update Date | 2015-11-04 |