| NPI | 1376991406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WA 60796431) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60796431) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2024-07-26 |