| NPI | 1932535903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 8041-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0005856) |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60400481) | |
| Enumeration Date | 2013-09-22 |
| Last Update Date | 2024-10-07 |