| NPI | 1447344833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60532939) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: NM 93-PA26) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2015-07-30 |