| NPI | 1285746446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 7794) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10003200) |
| 207P00000X Emergency Medicine (Licence: WA PA10003200) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-01-10 |