NPI | 1093168783 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60848209) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA60848209) |
363AS0400X Physician Assistant, Surgical (Licence: WA PA60848209) | |
Enumeration Date | 2016-07-18 |
Last Update Date | 2024-08-08 |