| NPI | 1073978680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 53129) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA.PA.60615465) |
| 363A00000X Physician Assistant (Licence: WA PA60615465) | |
| Enumeration Date | 2015-12-24 |
| Last Update Date | 2024-06-24 |