| NPI | 1538485180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-1008) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60141280) |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2024-11-05 |