| NPI | 1003007311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3808) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10004010) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2024-10-31 |