| NPI | 1144541350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60507650) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60471835) |
| 363A00000X Physician Assistant (Licence: WA PA60507650) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2022-07-21 |