| NPI | 1972577088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5180) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10003454) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2018-03-17 |