NPI | 1336156496 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-176) |
Additional Taxonomies | 363A00000X Physician Assistant |
363A00000X Physician Assistant (Licence: WA PA10003546) | |
Enumeration Date | 2006-08-02 |
Last Update Date | 2016-07-14 |