NPI | 1285806323 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 59627) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.004666) |
Enumeration Date | 2008-03-28 |
Last Update Date | 2023-03-28 |