NPI | 1679714620 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 52742) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 20203) |
Enumeration Date | 2009-03-20 |
Last Update Date | 2022-12-02 |