NPI | 1184142606 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-2587) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA60913443) |
Enumeration Date | 2017-09-05 |
Last Update Date | 2023-10-24 |