NPI | 1720696768 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61106151) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 14157) |
363A00000X Physician Assistant (Licence: MN 14157) | |
Enumeration Date | 2020-07-15 |
Last Update Date | 2024-10-28 |