NPI | 1962275941 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA63571) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA PA63571) |
Enumeration Date | 2023-11-01 |
Last Update Date | 2023-12-29 |