| NPI | 1528383627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MT MED-PAC-LIC-97431) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-08059) |
| 363A00000X Physician Assistant (Licence: CA PA22391) | |
| 363A00000X Physician Assistant (Licence: OR PA156586) | |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2021-12-14 |