NPI | 1417998055 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10004056) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10004056) |
363AS0400X Physician Assistant, Surgical (Licence: WA PA10004056) | |
Enumeration Date | 2006-06-08 |
Last Update Date | 2023-03-07 |