| NPI | 1194782631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NCCPA 1049196) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA 60105501) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2021-06-10 |