NPI | 1700428711 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA57291) |
Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 57291) |
Enumeration Date | 2019-10-10 |
Last Update Date | 2024-09-25 |