| NPI | 1831287564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60490220) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2059-023) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2024-01-03 |