NPI | 1659935989 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA56871) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA56871) |
Enumeration Date | 2019-04-22 |
Last Update Date | 2019-07-16 |