NPI | 1518562990 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61263794) |
Additional Taxonomies | 363A00000X Physician Assistant |
363A00000X Physician Assistant | |
Enumeration Date | 2020-12-02 |
Last Update Date | 2024-11-06 |