NPI | 1932672615 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 57670) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA 57670) |
Enumeration Date | 2019-01-06 |
Last Update Date | 2023-03-30 |