| NPI | 1275838385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WA OA60211117) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA OA60211117) |
| Enumeration Date | 2011-01-20 |
| Last Update Date | 2021-06-23 |