| NPI | 1811474448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61608033) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302042911) |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2024-11-25 |