| NPI | 1861899445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61553025) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 52172) |
| Enumeration Date | 2014-11-26 |
| Last Update Date | 2024-06-04 |