NPI | 1932153319 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA52547) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 003307) |
Enumeration Date | 2006-05-20 |
Last Update Date | 2015-11-11 |