| NPI | 1023359064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60384589) |
| Enumeration Date | 2013-03-14 |
| Last Update Date | 2024-06-25 |