| NPI | 1346221694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10004040) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA MP0603630) |
| Enumeration Date | 2005-11-11 |
| Last Update Date | 2017-01-23 |