NPI | 1922062090 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10003130) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA00003130) |
Enumeration Date | 2006-04-14 |
Last Update Date | 2015-06-17 |