| NPI | 1164513305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10005066) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA TA10005066) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-08-26 |