| NPI | 1548425309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001001538) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60528245) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2021-07-02 |