NPI | 1144753518 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA 60988491) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA56263) |
Enumeration Date | 2017-04-04 |
Last Update Date | 2019-10-16 |