| NPI | 1346719507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61189720) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 56269) |
| Enumeration Date | 2018-11-16 |
| Last Update Date | 2021-09-28 |