| NPI | 1518027903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60921354) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 2371) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2021-08-10 |