NPI | 1265967079 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA54845) |
Enumeration Date | 2017-04-29 |
Last Update Date | 2021-11-18 |