| NPI | 1245118132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA.PA.70025946) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WA PA.PA.70025946) |
| Enumeration Date | 2025-08-26 |
| Last Update Date | 2025-08-26 |