NPI | 1497825087 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA19844) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 5184009) |
Enumeration Date | 2006-11-09 |
Last Update Date | 2015-07-27 |