NPI | 1720405145 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA165739) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2014-03-24 |
Last Update Date | 2022-08-11 |