NPI | 1811921380 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA16676) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA16676) |
Enumeration Date | 2006-07-10 |
Last Update Date | 2021-11-22 |