NPI | 1366281925 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 64493) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA64493) |
Enumeration Date | 2024-05-23 |
Last Update Date | 2024-10-31 |