| NPI | 1528496858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA.60414655) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60414655) |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2021-02-23 |