NPI | 1710219621 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60182613) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA20478) |
363AM0700X Physician Assistant Medical (Licence: WA PA60182613) | |
363AM0700X Physician Assistant Medical (Licence: CA PA20478) | |
363AS0400X Physician Assistant Surgical (Licence: WA PA60182613) | |
363AS0400X Physician Assistant Surgical (Licence: CA PA20478) | |
Enumeration Date | 2010-02-02 |
Last Update Date | 2020-12-07 |