| NPI | 1437785268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA70082059) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA57779) |
| Enumeration Date | 2020-03-12 |
| Last Update Date | 2026-03-16 |