| NPI | 1144658253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA063449) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60419014) |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2022-09-15 |