| NPI | 1043323876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA367) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10004451) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2024-09-27 |