NPI | 1689756330 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA12108) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA12108) |
Enumeration Date | 2006-10-20 |
Last Update Date | 2024-09-20 |