| NPI | 1194243782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2756) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60900235) |
| Enumeration Date | 2017-09-02 |
| Last Update Date | 2024-08-09 |