| NPI | 1881112910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60797427) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60797427) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2017-09-08 |
| Last Update Date | 2021-09-09 |