| NPI | 1043441462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60108761) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 8971) |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2022-09-29 |