NPI | 1295701803 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10004575) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA PA10004575) |
Enumeration Date | 2006-02-23 |
Last Update Date | 2023-11-08 |