NPI | 1043323876 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA367) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10004451) |
Enumeration Date | 2006-08-16 |
Last Update Date | 2024-09-27 |