| NPI | 1295107670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60229693) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA OA60902560) |
| Enumeration Date | 2015-10-26 |
| Last Update Date | 2021-06-22 |