NPI | 1407137334 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA194316) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2782023) |
Enumeration Date | 2011-09-06 |
Last Update Date | 2023-10-12 |