| NPI | 1558356055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10003595) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2020-05-21 |