NPI | 1124056437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10003420) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA052594) |
Enumeration Date | 2006-06-28 |
Last Update Date | 2020-11-16 |