NPI | 1699867085 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA20723) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 004487) |
Enumeration Date | 2006-09-29 |
Last Update Date | 2015-09-25 |