| NPI | 1881062461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60698207) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA PA60698207) |
| Enumeration Date | 2015-09-13 |
| Last Update Date | 2025-03-31 |