NPI | 1720757172 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61229469) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2021-09-09 |
Last Update Date | 2022-03-11 |