| NPI | 1902058019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60053066) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA22437) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2021-04-01 |