NPI | 1356853386 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55093) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CA 55093) |
Enumeration Date | 2017-10-31 |
Last Update Date | 2023-09-26 |