| NPI | 1225543580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61427915) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085006439) |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2023-06-22 |