| NPI | 1861722290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 4919) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60128266) |
| Enumeration Date | 2010-01-07 |
| Last Update Date | 2023-07-11 |