NPI | 1174712624 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA20585) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002657) |
Enumeration Date | 2007-10-22 |
Last Update Date | 2015-06-15 |