NPI | 1144605908 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60923665) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA1435) |
Enumeration Date | 2015-07-22 |
Last Update Date | 2022-11-07 |