NPI | 1336370659 |
---|---|
Former Name | JAMES BRADY CALLOS |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60807124) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA20432) |
363AM0700X Physician Assistant, Medical (Licence: WA PA60807124) | |
363AM0700X Physician Assistant, Medical (Licence: CA PA20432) | |
Enumeration Date | 2009-08-04 |
Last Update Date | 2018-06-20 |