NPI | 1902289960 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA61035740) |
Enumeration Date | 2015-07-08 |
Last Update Date | 2024-07-11 |