| NPI | 1083955090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA.PA.61311294) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK PAD T 2368) |
| 363AM0700X Physician Assistant, Medical (Licence: AK 1211) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2022-10-06 |