NPI | 1346232311 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA 10547) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA 10547) |
363AS0400X Physician Assistant, Surgical (Licence: CA PA10547) | |
Enumeration Date | 2005-08-16 |
Last Update Date | 2011-04-05 |