| NPI | 1750732186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 63281) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR 177179) |
| 363A00000X Physician Assistant (Licence: WA 60666454) | |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2024-04-25 |