NPI | 1710186721 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA ML5329) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9103047) |
363A00000X Physician Assistant | |
Enumeration Date | 2007-07-11 |
Last Update Date | 2020-08-31 |