NPI | 1215008412 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA17460) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA17460) |
Enumeration Date | 2006-11-11 |
Last Update Date | 2014-06-11 |