| NPI | 1487277836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID 8171659) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61356852) |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2025-12-12 |