NPI | 1427452648 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 56982) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical |
Enumeration Date | 2014-10-17 |
Last Update Date | 2024-07-18 |