| NPI | 1396227583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61471148) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2023-10-12 |