| NPI | 1063468403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10004026) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA PA10004026) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2011-11-21 |