NPI | 1578596631 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10004144) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10004144) |
Enumeration Date | 2006-07-09 |
Last Update Date | 2025-08-27 |