NPI | 1487960910 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA21121) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA21121) |
Enumeration Date | 2010-08-21 |
Last Update Date | 2013-01-28 |