NPI | 1457540825 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10005323) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10005323) |
Enumeration Date | 2007-10-22 |
Last Update Date | 2019-07-19 |