| NPI | 1437466604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113147) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 15687) |
| 183500000X Pharmacist (Licence: WA PH60136177) | |
| 363A00000X Physician Assistant (Licence: WA PA60135328) | |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2020-05-18 |