| NPI | 1841468410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2289) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1091) |
| 363A00000X Physician Assistant (Licence: WA PA60720417) | |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2023-11-14 |