NPI | 1043941289 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61310949) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2022-06-20 |
Last Update Date | 2022-08-26 |