| NPI | 1235137571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA61470036) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10000255A) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2024-03-12 |