NPI | 1013245851 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA 60123694) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA 60123694) |
363AS0400X Physician Assistant, Surgical (Licence: WA 60123694) | |
Enumeration Date | 2009-12-04 |
Last Update Date | 2009-12-04 |