| NPI | 1043456478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60623445) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA179307) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2020-04-28 |