NPI | 1740606920 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA55394) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 017304) |
Enumeration Date | 2014-03-11 |
Last Update Date | 2023-08-02 |