| NPI | 1437702057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA61650090) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-16672) |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2026-07-07 |