| NPI | 1417347915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60555593) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5962) |
| 363A00000X Physician Assistant (Licence: OR PA195076) | |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2023-03-29 |