| NPI | 1740238310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA OA60051678) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10003927) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2011-07-12 |