NPI | 1992021091 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60135305) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA59493) |
363A00000X Physician Assistant | |
Enumeration Date | 2010-04-14 |
Last Update Date | 2025-03-14 |