| NPI | 1912384181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 52449) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60925800) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2022-03-24 |