| NPI | 1275952889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA NC10074310) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA 60449795) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2020-12-07 |