NPI | 1285010322 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 53159) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 081905) |
Enumeration Date | 2015-07-30 |
Last Update Date | 2021-02-11 |