| NPI | 1649768995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2018013136) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61599890) |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2025-01-09 |