NPI | 1861953499 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 63568) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 4551) |
Enumeration Date | 2019-03-27 |
Last Update Date | 2024-04-11 |