| NPI | 1356694350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61117345) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA157168) |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2021-10-19 |