| NPI | 1083798532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA-10005297) |
| Additional Taxonomies | 227800000X Respiratory Therapist, Certified |
| 363A00000X Physician Assistant (Licence: AK 728) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2012-01-23 |