NPI | 1982115275 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 55075) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 55075) |
Enumeration Date | 2017-10-13 |
Last Update Date | 2020-01-16 |