NPI | 1588121354 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 58091) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SD 1269) |
Enumeration Date | 2019-02-27 |
Last Update Date | 2025-06-07 |