| NPI | 1144504606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60544695) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 7158173-1206) |
| Enumeration Date | 2011-10-03 |
| Last Update Date | 2015-05-21 |