NPI | 1417293580 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA22729) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016391) |
Enumeration Date | 2012-12-18 |
Last Update Date | 2015-06-04 |