| NPI | 1265503742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AK 260) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA PA 1004563) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2007-07-08 |