NPI | 1821589524 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA55879) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: CA PA55879) |
Enumeration Date | 2018-05-29 |
Last Update Date | 2021-12-06 |