| NPI | 1407803588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 3392) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA1865293) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2020-02-05 |