NPI | 1336543008 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60509828) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60509828) |
Enumeration Date | 2014-10-09 |
Last Update Date | 2019-06-10 |