| NPI | 1770908907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60420918) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA 60420918) |
| Enumeration Date | 2014-02-25 |
| Last Update Date | 2019-03-18 |