NPI | 1396132015 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60614067) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60614067) |
Enumeration Date | 2015-04-21 |
Last Update Date | 2025-07-22 |