NPI | 1538604822 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55959) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 020488) |
Enumeration Date | 2016-12-22 |
Last Update Date | 2022-10-26 |