NPI | 1568711398 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60572197) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 125566) |
363A00000X Physician Assistant (Licence: OK APA2167) | |
Enumeration Date | 2012-09-07 |
Last Update Date | 2024-06-06 |