| NPI | 1679130322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60912831) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2022-06-02 |