| NPI | 1558540385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WA PA10005325) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: FL PA9116089) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2022-06-22 |