NPI | 1679526842 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 14002) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA14002) |
363AM0700X Physician Assistant, Medical (Licence: CA PA14002) | |
Enumeration Date | 2006-05-18 |
Last Update Date | 2015-12-30 |