| NPI | 1295110237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60833443) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05800) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2018-06-14 |