NPI | 1528050457 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA13404) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA13404) |
363AS0400X Physician Assistant, Surgical (Licence: CA PA13404) | |
Enumeration Date | 2005-08-17 |
Last Update Date | 2008-04-10 |