NPI | 1033565270 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61458444) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2016-0035) |
Enumeration Date | 2016-05-06 |
Last Update Date | 2024-03-27 |