| NPI | 1023004033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10004049) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA16841) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2024-04-08 |