NPI | 1417288275 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA20636) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA20636) |
Enumeration Date | 2010-01-19 |
Last Update Date | 2015-04-13 |