| NPI | 1548618432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA 60810745) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60810745) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2025-01-15 |