| NPI | 1386327641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61480284) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA TA61482481) |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2023-10-03 |