| NPI | 1427045780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10004240) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2018009747) |
| 363A00000X Physician Assistant (Licence: ID PA-849) | |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2020-12-02 |