| NPI | 1477982577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 112856) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1470) |
| 363A00000X Physician Assistant (Licence: WA PA60999636) | |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2024-04-05 |