| NPI | 1487675815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 52521) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10003943) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2022-11-09 |