| NPI | 1851075477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61450103) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9116959) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2024-04-24 |