NPI | 1497834402 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA16167) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 16167) |
Enumeration Date | 2006-11-02 |
Last Update Date | 2023-03-07 |