NPI | 1679971352 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PSY58721) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA 60512154) |
Enumeration Date | 2014-12-12 |
Last Update Date | 2024-01-18 |