| NPI | 1003923293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: OR PA00498) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WA PA10003619) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2007-07-08 |