NPI | 1225110836 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 18025) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 18025) |
363AM0700X Physician Assistant, Medical (Licence: CA 18025) | |
Enumeration Date | 2006-10-20 |
Last Update Date | 2020-08-27 |