| NPI | 1750728788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA61000052) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: DC PA030947) |
| 363AM0700X Physician Assistant, Medical (Licence: MD C0006788) | |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2025-09-19 |