NPI | 1902491707 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA61491021) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD-1033) |
363A00000X Physician Assistant (Licence: WA PA61491021) | |
Enumeration Date | 2021-03-03 |
Last Update Date | 2024-08-15 |