NPI | 1407009624 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA20034) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA20034) |
Enumeration Date | 2008-10-31 |
Last Update Date | 2015-06-12 |