| NPI | 1336296193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61397889) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61397889) |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 103305) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2024-08-14 |