NPI | 1881112910 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60797427) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60797427) |
363A00000X Physician Assistant | |
Enumeration Date | 2017-09-08 |
Last Update Date | 2021-09-09 |