NPI | 1538723937 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61135685) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 23.004437) |
363AS0400X Physician Assistant Surgical (Licence: CT 4437) | |
Enumeration Date | 2019-05-01 |
Last Update Date | 2021-04-19 |