NPI | 1740613041 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CA PA23072) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA23072) |
Enumeration Date | 2013-08-10 |
Last Update Date | 2014-06-30 |