| NPI | 1427670520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61323159) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 5039-23) |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2024-10-15 |