| NPI | 1598863177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA WA PA10003987) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR OR PA00152) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2008-03-26 |