| NPI | 1891814455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10004132) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA PA10004132) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2021-05-25 |