NPI | 1669820213 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60668494) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2016-05-24 |
Last Update Date | 2024-02-29 |