| NPI | 1396132015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60614067) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60614067) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2025-07-22 |