| NPI | 1316385875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60838852) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 1108842) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2023-05-15 |