| NPI | 1588086664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60614356) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 5636) |
| Enumeration Date | 2014-01-09 |
| Last Update Date | 2021-04-27 |