| NPI | 1649218546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA PA10003728) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10003728) |
| 363A00000X Physician Assistant (Licence: WA 1039568) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2021-05-18 |