NPI | 1215079991 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA 10001608) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10001608) |
Enumeration Date | 2007-02-12 |
Last Update Date | 2011-03-01 |