| NPI | 1275948168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60800069) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2024-09-03 |