NPI | 1174033807 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 58094) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 6942) |
Enumeration Date | 2017-10-09 |
Last Update Date | 2024-05-07 |