| NPI | 1831486091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60676871) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.003233) |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60676871) | |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2016-08-25 |