| NPI | 1558407221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA10003861) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA 10003861) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2019-08-02 |