| NPI | 1235420753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60629545) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA203640) |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2023-08-16 |