NPI | 1881801405 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA208148) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ID PA-657) |
Enumeration Date | 2007-05-16 |
Last Update Date | 2022-05-03 |