| NPI | 1346326204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60197224) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA 60197224) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2011-01-13 |