| NPI | 1194449074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA61358839) |
| 363AM0700X Physician Assistant, Medical (Licence: OR PA214588) | |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2023-08-09 |