| NPI | 1568600492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PAPA60207408) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1124) |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60207408) | |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA60207408) | |
| Enumeration Date | 2009-01-30 |
| Last Update Date | 2016-09-26 |