NPI | 1144713876 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60928860) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2018-06-07 |
Last Update Date | 2025-07-17 |