NPI | 1285245894 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA60166) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9115952) |
Enumeration Date | 2020-08-17 |
Last Update Date | 2025-02-06 |