NPI | 1528170503 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA01051) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10003541) |
Enumeration Date | 2006-08-31 |
Last Update Date | 2016-02-03 |