NPI | 1447624911 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 53309) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 7659) |
Enumeration Date | 2015-11-21 |
Last Update Date | 2024-02-15 |