NPI | 1558462515 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA17622) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA17622) |
Enumeration Date | 2006-09-25 |
Last Update Date | 2013-04-19 |