NPI | 1629304332 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5421) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA20580) |
Enumeration Date | 2009-10-30 |
Last Update Date | 2020-10-15 |