| NPI | 1285630822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WA PA10003809) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA0003809) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2019-08-15 |