| NPI | 1306997853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10000386) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA MY0119556) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2007-10-18 |