| NPI | 1972932986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 5808460-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA.60423331) |
| Enumeration Date | 2013-11-11 |
| Last Update Date | 2024-10-18 |