| NPI | 1336579663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60601346) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 51314) |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2021-03-25 |