| NPI | 1528526993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60964856) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA TA60987863) |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2022-09-19 |