| NPI | 1285229500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61409222) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA208018) |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2024-10-30 |