NPI | 1619023769 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA 18366) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT20351) |
Enumeration Date | 2007-01-25 |
Last Update Date | 2007-11-17 |