| NPI | 1306988514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 1069) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10004583) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2023-03-07 |