NPI | 1982121125 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA OA60920124) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ID PA-1845) |
363AM0700X Physician Assistant, Medical (Licence: WA PA60920248) | |
Enumeration Date | 2017-08-28 |
Last Update Date | 2020-07-14 |