| NPI | 1215356563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA60510268) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2019-12-18 |