| NPI | 1639378565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA10003054) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA03292) |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA100003054) | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2015-02-19 |