| NPI | 1568711398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60572197) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 125566) |
| 363A00000X Physician Assistant (Licence: OK APA2167) | |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2024-06-06 |