| NPI | 1073572376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA10001953) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA OA60078618) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2012-10-23 |