NPI | 1922356260 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA 60672189) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015886) |
363A00000X Physician Assistant (Licence: MD C06755) | |
Enumeration Date | 2012-08-16 |
Last Update Date | 2024-02-28 |