| NPI | 1255959003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61593978) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA210726) |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2024-09-12 |