| NPI | 1194927400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA 10003832) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085-002719) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2023-04-17 |