NPI | 1144542457 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1767) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA21543) |
Enumeration Date | 2010-02-28 |
Last Update Date | 2024-02-20 |