| NPI | 1225341472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60253264) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 00000) |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2021-05-19 |