| NPI | 1356380836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10003768) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10003768) |
| 363A00000X Physician Assistant (Licence: MT 91790) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2022-11-07 |