| NPI | 1013217751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60188670) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60188670) |
| 363A00000X Physician Assistant (Licence: OR PA158179) | |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60188670) | |
| 363AM0700X Physician Assistant, Medical (Licence: SD 0796) | |
| Enumeration Date | 2010-10-28 |
| Last Update Date | 2020-09-04 |