NPI | 1043441462 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60108761) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 8971) |
Enumeration Date | 2009-08-03 |
Last Update Date | 2022-09-29 |