NPI | 1669541330 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA20770) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA20770) |
Enumeration Date | 2006-11-07 |
Last Update Date | 2018-03-17 |