| NPI | 1043768377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60953038) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA189762) |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2019-07-23 |