| NPI | 1821216284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA01254) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN 00070001) |
| 363A00000X Physician Assistant (Licence: WA PA10003531) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2008-11-11 |