| NPI | 1932453016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ND PAC0604) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61514645) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2025-05-21 |