| NPI | 1366435943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA10004886) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10004886) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2007-12-12 |