| NPI | 1437196870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60120173) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 004184) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2010-01-11 |