NPI | 1093406985 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA61459657) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61459657) |
Enumeration Date | 2023-05-19 |
Last Update Date | 2024-09-27 |