NPI | 1376594747 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA20735) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601004165) |
Enumeration Date | 2006-05-12 |
Last Update Date | 2021-11-30 |