| NPI | 1881613032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60921551) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002020) |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60921551) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-11-08 |