NPI | 1245391390 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60434156) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2006-12-13 |
Last Update Date | 2014-12-29 |