| NPI | 1508960998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA pa10001085) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR pa00342) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2007-07-08 |