| NPI | 1649689126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60808617) |
| 363A00000X Physician Assistant (Licence: TX PA11007) | |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60808617) | |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2025-11-24 |