NPI | 1245471580 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA20695) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9104705) |
Enumeration Date | 2009-03-17 |
Last Update Date | 2011-09-12 |