NPI | 1497799555 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA156119) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WY TL 360) |
Enumeration Date | 2006-06-16 |
Last Update Date | 2024-10-03 |