NPI | 1982808234 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 51333) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA TMA051734) |
Enumeration Date | 2007-06-12 |
Last Update Date | 2015-07-23 |