NPI | 1831738905 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA218600) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61185813) |
363AS0400X Physician Assistant, Surgical (Licence: WA PA61185813) | |
Enumeration Date | 2020-01-06 |
Last Update Date | 2025-07-31 |