NPI | 1891737888 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 2365-23) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA pa15906) |
Enumeration Date | 2006-06-12 |
Last Update Date | 2021-04-23 |