| NPI | 1295708378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10004442) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA00907) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2007-07-08 |