| NPI | 1316258767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA61159161) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA PA61159161) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2024-07-24 |