| NPI | 1124056437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10003420) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA052594) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2020-11-16 |