NPI | 1760847057 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA179531) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61101176) |
Enumeration Date | 2015-12-31 |
Last Update Date | 2025-03-11 |