NPI | 1568801181 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 53357) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA60386057) |
Enumeration Date | 2013-06-17 |
Last Update Date | 2017-05-08 |