NPI | 1750728788 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA61000052) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: DC PA030947) |
363AM0700X Physician Assistant, Medical (Licence: MD C0006788) | |
Enumeration Date | 2013-05-31 |
Last Update Date | 2020-10-07 |