| NPI | 1821498296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60520518) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA OA60534015) |
| 363A00000X Physician Assistant (Licence: OR PA186181) | |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2018-06-26 |