NPI | 1942519046 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61138779) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MO 2014025050) |
Enumeration Date | 2010-10-07 |
Last Update Date | 2024-10-01 |