NPI | 1891002606 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60749442) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
363A00000X Physician Assistant (Licence: KS 15-01515) | |
363AS0400X Physician Assistant, Surgical | |
Enumeration Date | 2010-09-01 |
Last Update Date | 2021-04-28 |