NPI | 1467846147 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA53605) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05629) |
Enumeration Date | 2015-03-20 |
Last Update Date | 2020-12-04 |