NPI | 1679577241 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10002281) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10002281) |
Enumeration Date | 2005-06-10 |
Last Update Date | 2021-06-09 |