| NPI | 1821008566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 7804) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10003185) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2022-03-15 |