| NPI | 1700950425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 004425) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA 10003934) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2015-08-24 |