| NPI | 1023488756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60906160) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 3444) |
| 363A00000X Physician Assistant (Licence: MD C0006354) | |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2023-10-10 |