| NPI | 1629451729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60975375) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA53438) |
| 363A00000X Physician Assistant (Licence: NV PA1633) | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2023-09-07 |