NPI | 1669139879 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA60602) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA2557) |
363A00000X Physician Assistant | |
Enumeration Date | 2021-11-22 |
Last Update Date | 2024-09-19 |