NPI | 1326067679 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10005034) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10005034) |
Enumeration Date | 2006-07-18 |
Last Update Date | 2019-08-27 |