NPI | 1548892110 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2484) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA57810) |
363AM0700X Physician Assistant, Medical (Licence: CA PA57810) | |
Enumeration Date | 2020-02-11 |
Last Update Date | 2024-08-08 |