| NPI | 1447308333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WA PA.60225003) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA11925) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2012-02-02 |