NPI | 1194884098 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C07116) |
363A00000X Physician Assistant (Licence: WA PA60277854) | |
Enumeration Date | 2006-12-06 |
Last Update Date | 2020-10-27 |