| NPI | 1528151206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA00641) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10004785) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2007-07-10 |