| NPI | 1649448572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-913) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10005374) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2021-05-17 |