| NPI | 1508350539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61055470) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2021-01-06 |