NPI | 1164073276 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60976825) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60976825) |
Enumeration Date | 2019-09-20 |
Last Update Date | 2022-10-28 |