| NPI | 1194884098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C07116) |
| 363A00000X Physician Assistant (Licence: WA PA60277854) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2020-10-27 |