NPI | 1780679068 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA446) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10004517) |
Enumeration Date | 2005-09-13 |
Last Update Date | 2024-07-19 |