| NPI | 1114072113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WA PA10000127) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WA PA10000127) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2013-08-27 |