NPI | 1225302219 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA22131) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 22131) |
Enumeration Date | 2012-03-08 |
Last Update Date | 2012-07-13 |