| NPI | 1235256272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60905259) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 2687) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2019-10-02 |