| NPI | 1245484781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60051207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA PA60051207) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2023-03-07 |