| NPI | 1891309555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61102743) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2022-03-24 |