NPI | 1306119417 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA51700) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 00100339NC) |
363AM0700X Physician Assistant, Medical (Licence: NC 0010-03399) | |
363AS0400X Physician Assistant, Surgical (Licence: NC 0010-03399) | |
Enumeration Date | 2012-02-21 |
Last Update Date | 2020-09-23 |