| NPI | 1528275823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60633795) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 0250 P) |
| 363A00000X Physician Assistant (Licence: WA PA60633795) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2016-05-19 |