NPI | 1609990167 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA16984) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 008000-1) |
Enumeration Date | 2007-03-19 |
Last Update Date | 2007-07-08 |