| NPI | 1477699239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA10004491) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10004491) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2023-09-18 |