NPI | 1336579663 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60601346) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 51314) |
Enumeration Date | 2013-11-22 |
Last Update Date | 2021-03-25 |