| NPI | 1285942987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-04207) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD T0004301) |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60225024) | |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2013-07-01 |