NPI | 1518454396 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 57007) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 7061) |
Enumeration Date | 2018-04-17 |
Last Update Date | 2024-04-16 |