NPI | 1952927907 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 58534) |
Additional Taxonomies | 363A00000X Physician Assistant |
363A00000X Physician Assistant (Licence: WA PA61561413) | |
Enumeration Date | 2020-06-24 |
Last Update Date | 2024-09-17 |