| NPI | 1497771463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 61106) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10005336) |
| 363A00000X Physician Assistant (Licence: OR PA00879) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2022-06-22 |