| NPI | 1871521864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA10003813) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA PA10003813) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2023-08-09 |