| NPI | 1104145481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54418) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA.PA.60139142) |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2017-10-23 |