| NPI | 1023211729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA10002695) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00099637) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2024-04-02 |