| NPI | 1659462448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA10002668) |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: WA PA10002668) |
| 207RN0300X Internal Medicine, Nephrology (Licence: ID PA506) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2014-08-29 |