NPI | 1710036587 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10004262) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 11053) |
Enumeration Date | 2007-01-09 |
Last Update Date | 2016-10-24 |