NPI | 1356526495 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA19534) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 19534) |
Enumeration Date | 2008-01-08 |
Last Update Date | 2010-08-17 |