| NPI | 1497362354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61109280) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2021-06-15 |