| NPI | 1215032982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10005086) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA PA 15805) |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA15805) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2022-02-02 |