| NPI | 1144370032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA 60705908) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 10535560) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2020-07-29 |