NPI | 1427661966 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61574147) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-10514) |
Enumeration Date | 2020-08-25 |
Last Update Date | 2024-11-19 |