NPI | 1932535903 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60400481) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0005856) |
Enumeration Date | 2013-09-22 |
Last Update Date | 2019-07-23 |