NPI | 1295858215 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA PA17760) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA17760) |
Enumeration Date | 2007-04-06 |
Last Update Date | 2018-03-17 |