NPI | 1689280331 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA59074) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2020-09-18 |
Last Update Date | 2022-08-15 |