NPI | 1316460249 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA54984) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2017-07-23 |
Last Update Date | 2019-04-05 |