NPI | 1346648482 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60520562) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2014-12-05 |
Last Update Date | 2022-06-08 |