NPI | 1245296144 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PAC20405) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA20405) |
Enumeration Date | 2006-04-21 |
Last Update Date | 2025-07-23 |