NPI | 1730113101 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA14440) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA14440) |
Enumeration Date | 2006-07-10 |
Last Update Date | 2021-12-13 |