NPI | 1326203936 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 10432) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 000902) |
Enumeration Date | 2008-07-23 |
Last Update Date | 2008-07-23 |