| NPI | 1316208895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60961599) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WA AC60236931) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2023-02-15 |