NPI | 1932389087 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10005311) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO PA.1234567) |
Enumeration Date | 2007-11-06 |
Last Update Date | 2024-12-12 |