| NPI | 1366846636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2179) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA 60502966) |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2024-05-20 |