NPI | 1295296622 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61286749) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 57014) |
Enumeration Date | 2019-03-28 |
Last Update Date | 2025-07-03 |