| NPI | 1770715112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WA PA60188697) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2009-08-19 |
| Last Update Date | 2018-11-05 |