NPI | 1336994110 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 10004) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 1983) |
Enumeration Date | 2024-04-23 |
Last Update Date | 2024-07-18 |