| NPI | 1902491707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA61491021) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD-1033) |
| 363A00000X Physician Assistant (Licence: WA PA61491021) | |
| Enumeration Date | 2021-03-03 |
| Last Update Date | 2024-08-15 |