| NPI | 1184142606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: ID PA-2587) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WA PA60913443) |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2023-10-24 |