NPI | 1265999056 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 11111343-1206) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60942025) |
Enumeration Date | 2019-02-27 |
Last Update Date | 2024-03-15 |