| NPI | 1851638407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60313083) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA TA60314893) |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60313083) | |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2023-03-08 |