NPI | 1265669758 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA21467) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013288) |
Enumeration Date | 2009-06-11 |
Last Update Date | 2014-01-30 |