| NPI | 1407007412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA.PA.70013431) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 11918893-1206) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2025-08-07 |