NPI | 1912367830 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55705) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA058153) |
Enumeration Date | 2016-03-04 |
Last Update Date | 2024-12-13 |