| NPI | 1033565270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61458444) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2016-0035) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2024-03-27 |