| NPI | 1093721789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10003149) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 20347) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2021-04-22 |