NPI | 1972688703 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA60143) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10003885) |
Enumeration Date | 2006-10-27 |
Last Update Date | 2022-10-06 |