| NPI | 1598902215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60201520) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA1802) |
| 363A00000X Physician Assistant (Licence: KS 15-02830) | |
| Enumeration Date | 2009-01-16 |
| Last Update Date | 2025-03-28 |