| NPI | 1629610050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61267486) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 57173) |
| 363A00000X Physician Assistant (Licence: NY 026144) | |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2025-01-22 |