| NPI | 1891002606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60749442) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363A00000X Physician Assistant (Licence: KS 15-01515) | |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2021-04-28 |