| NPI | 1457322703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60055107) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OK 1469) |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60055107) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2011-04-19 |