NPI | 1326151721 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60345431) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2006-08-17 |
Last Update Date | 2013-05-29 |