NPI | 1437748191 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 62817) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA2442) |
Enumeration Date | 2021-01-15 |
Last Update Date | 2024-01-29 |