| NPI | 1538388400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60604308) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: ID PA342) |
| 146D00000X Personal Emergency Response Attendant (Licence: CO 2936) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2017-01-23 |