NPI | 1053492421 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA 10005151) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 491) |
363A00000X Physician Assistant (Licence: WA PA10005151) | |
Enumeration Date | 2006-10-18 |
Last Update Date | 2015-05-04 |