| NPI | 1306144126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60540093) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105965) |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2022-07-21 |