NPI | 1912152265 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60056491) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA 60056491) |
Enumeration Date | 2008-11-28 |
Last Update Date | 2016-06-29 |