| NPI | 1295296622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61286749) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 57014) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2023-03-01 |