NPI | 1215075684 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10003587) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 004984) |
Enumeration Date | 2007-02-01 |
Last Update Date | 2018-03-17 |