| NPI | 1598112443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006180) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60807198) |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60807198) | |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2020-05-28 |