NPI | 1265450092 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA .60236031) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IA 001656) |
Enumeration Date | 2006-07-18 |
Last Update Date | 2012-09-25 |