NPI | 1972865582 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60299976) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 138797) |
Enumeration Date | 2012-06-10 |
Last Update Date | 2023-11-02 |