| NPI | 1366746786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61036629) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX 1092365) |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2020-12-22 |