| NPI | 1801291034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WA PA61531662) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61531662) |
| 363AS0400X Physician Assistant Surgical (Licence: OR PA169239) | |
| 363AS0400X Physician Assistant Surgical (Licence: CO PA.0004839) | |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2024-05-21 |