| NPI | 1518914290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110002807) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA156566) |
| 363A00000X Physician Assistant (Licence: NH 0479) | |
| 363A00000X Physician Assistant (Licence: WA PA60485011) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2023-12-15 |