| NPI | 1104483783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61261831) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA56794) |
| 363A00000X Physician Assistant (Licence: WA PA61261831) | |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2024-03-21 |