NPI | 1801454640 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60978802) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60978802) |
Enumeration Date | 2019-06-05 |
Last Update Date | 2022-11-29 |