| NPI | 1235697376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA61637192) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 56639) |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2026-06-04 |