| NPI | 1265735070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60193398) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2025-02-28 |