| NPI | 1558306373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10004348) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA PA10004348) |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA10004348) | |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2015-02-18 |