NPI | 1396227583 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61471148) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2018-09-04 |
Last Update Date | 2023-10-12 |