NPI | 1700336120 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60700306) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA 60700306) |
Enumeration Date | 2016-10-10 |
Last Update Date | 2016-11-18 |