| NPI | 1588893093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60370754) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: WA TA60393872) |
| 207X00000X Orthopaedic Surgery (Licence: WA TA60393872) | |
| 363A00000X Physician Assistant (Licence: WA TA603983872) | |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2016-05-07 |