| NPI | 1144277997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 70432) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10003222) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2018-12-27 |