| NPI | 1023314820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA OA60630396) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA OA60630396) |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: WA OA60630396) | |
| 363A00000X Physician Assistant (Licence: WA PA60539707) | |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2022-04-11 |