| NPI | 1295204600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA MH5598810) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA XH5598810) |
| 363A00000X Physician Assistant (Licence: MP 100) | |
| 363A00000X Physician Assistant (Licence: WA PA60998952) | |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2025-04-17 |