NPI | 1851638407 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60313083) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA TA60314893) |
363AM0700X Physician Assistant, Medical (Licence: WA PA60313083) | |
Enumeration Date | 2013-01-15 |
Last Update Date | 2023-03-08 |