NPI | 1285148569 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60858607) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 55592) |
363A00000X Physician Assistant (Licence: NV PA2190) | |
Enumeration Date | 2017-11-25 |
Last Update Date | 2022-11-03 |