| NPI | 1720001092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WA PA10003463) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2013-04-30 |