| NPI | 1245308527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 53841) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60739073) |
| Enumeration Date | 2006-12-02 |
| Last Update Date | 2018-06-11 |