NPI | 1205855574 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10004215) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA PA10004215) |
Enumeration Date | 2006-07-18 |
Last Update Date | 2019-07-16 |