| NPI | 1184177412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 083662) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61456947) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2023-07-31 |