| NPI | 1154774776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA 10003784) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH 00017312) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2016-07-19 |