| NPI | 1295822740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10002153) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: WA 25800059197) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2013-03-22 |