| NPI | 1902289960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA61035740) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2024-07-11 |