| NPI | 1316951965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA10004710) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10004710) |
| 363A00000X Physician Assistant (Licence: WA PA10004710) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2014-09-15 |