| NPI | 1649259482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8735) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10004151) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2024-04-16 |