NPI | 1427578376 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA60343) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TN 3348) |
363A00000X Physician Assistant (Licence: TN 3348) | |
363AS0400X Physician Assistant, Surgical (Licence: TN 3348) | |
Enumeration Date | 2017-06-21 |
Last Update Date | 2024-10-22 |