NPI | 1013217751 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60188670) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60188670) |
363A00000X Physician Assistant (Licence: OR PA158179) | |
363AM0700X Physician Assistant, Medical (Licence: WA PA60188670) | |
363AM0700X Physician Assistant, Medical (Licence: SD 0796) | |
Enumeration Date | 2010-10-28 |
Last Update Date | 2020-09-04 |