NPI | 1194251983 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60764325) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2017-05-11 |
Last Update Date | 2023-08-04 |