NPI | 1982990727 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60451718) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2011-06-20 |
Last Update Date | 2014-06-06 |