| NPI | 1497137889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60699355) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9108812) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2017-02-01 |